Mary Barnes' autobiography is one of the frankest
and most literal accounts of madness you are likely to read. From her
description of her early family life to the sometimes tediously detailed
description of her day to day experience of regression into psychosis, Barnes
spares herself and the reader little. Interspersed with sections by her
therapist, Joseph Berkes, and with new epilogues added since the publication of
the 1971 edition, the book spans the entire period of Barnes' life until her
death in 2001.

Barnes' story is not simply an
autobiography, but a first-person account (two if you include Berkes') of a
tumultuous time in British psychiatry. The asylum era had faltered under the
weight of internal critique, public distrust, and the seemingly limitless
capacity of society to consign the mentally ill to institutions. New theories
of mental illness, especially schizophrenia, were emerging. In particular,
psychoanalytically oriented theorists were looking at the role of the family in
schizophrenia. Thus Barnes' personal life history followed a path toward, and
then away from the mainstream of British psychiatry.

Barnes begins with the ironic
comment: 'My family was abnormally nice'. From there she recalls a childhood
under the austere gaze of her mother, and her struggle to live with the
conflicts carried into her adult life. She recounts early experiences of her
reaction to her mother's pregnancies, and her sense of rejection, displacement
and rage. Trained as a nurse, and for a time employed teaching nursing, Barnes'
life does not show the trajectory of adolescent role failure often considered
to characterize schizophrenia. Her conversion to Catholicism showed a concern
with questions of meaning that were later to assume almost mystical
proportions. According to her account Barnes achieved considerable success
professionally, but remained troubled by self doubt and at times delusional
ideas about herself, her family, and her effects on the world around her. These
led to hospital admissions and intervention with the standard treatments of the
time, ECT and chlorpromazine. When she met R.D Laing her life changed, and it
is here that the biography takes on and additional social and historical
interest.

In 1965 Barnes entered Kingsley
Hall, a therapeutic community set up by antipsychiatrists Laing and Esterson.
The mood was radical; the techniques primitive and untried. Laing considered
psychosis to be a healing experience which, fully experienced would bring about
its own resolution. Laing was the enfant terrible of British psychiatry
in the 1960s. His somewhat precocious The Divided Self set out what he
saw as the basis for an alternative scientific account of schizophrenia, that
of schizophrenia as an indicator of pathological family interaction. Kingsley
Hall was the crucible in which Laing's ideas would be tested. Barnes would
become one of Laing's ambassadors; a voyager into the depths of psychosis, who
would emerge to explain its mysteries to those who would listen. A lot of
people listened. Kingsley Hall, during the time of Mary Barnes residency,
became a magnet for radical thinkers in psychiatry. Visitors included Fritz Perls
and Loren Mosher. As mainstream resistance to Laing's ideas became more
entrenched, his critique took on an explicit political dimension through his
identification with concerns of emancipation and liberation, rather than merely
the alleviation of distress.

According to Berkes' account,
doctors working at Kingsley Hall were exhorted to drop their medical persona,
and instead engage with their clients as one human being to another. There
seems to be little that is problematic about such an attitude. Many doctors of
the day, especially those who were psychoanalytically trained, would probably
have agreed that the relationship between doctor and patient is the prime
ingredient of psychiatric care. Michael Balint's 1957 The Doctor, his Patient and the Illness certainly took such ideas seriously in applying them to
general medicine. However it is not entirely clear that Laing and others were
prepared to abandon the status arising from their background as doctors. Their
role as therapists appears in large part derived from their medical authority,
augmented by a considerable dose of personal charisma. At one point in Berkes'
therapy with Mary Barnes, Berkes lashed out in frustration at Barnes' childish
demands, bloodying her nose. What is notable about his response is his
consternation at finding himself thinking in terms of the ethical framework of
medicine. He is later relieved that Barnes thanked him for the assault and said
“she loved me more than ever”.

As she emerged from the cocoon of
psychosis Barnes' discovered a talent for art. She became a productive and
respected painter, not merely in the 'art of the insane' tradition, but in her
own right, as an artist of the unconscious. The book contains several reproductions
of her work, and they certainly have evocative power. One painting, 'The
resurrection' seems clearly modelled on Munch's The Scream, but the
embryo-like figure suggests the idea of rebirth which was a cornerstone of Laingian
therapy. Roman Catholic iconography is strongly represented in her art, with
the fingerpainted works on Peter, the Nativity, and The Blinding of Paul having
a primal quality in both the colors and the interpretations of their themes.

Two Accounts of a Journey
through Madness is at times a slow read. There is little evidence of
professional editing, which may be a reflection of the Barnes' view that
madness speaks directly, and should not be filtered through objective the
frames of reference for the convenience of others. Whatever the reason for its
publication in this form, the authentic voice of Barnes contributes in large
measure to the book's appeal. While there are passages in which the tone of her
writing is prosaic, there are others that show the poetic sensitivity that inspired
her art. Her view of herself is that: 'Much of me was twisted and buried,
and turned in on itself, like a tangled skein of wool, to which the end had
been lost.' (p. 13).

Mary Barnes was never cured.
Perhaps she was never ill. She lived a productive, fulfilled life, albeit one
interrupted by her admissions to hospital and her sponsored descents into
psychosis at Kingsley Hall. She contemplated death with equanimity. It is hard
to imagine the events of her life being repeated. That is not to say that psychiatry
has been reformed by the lessons of the antipsychiatrists. If anything, the
ideological position of biological psychiatrists has been strengthened, rather
than weakened over the past few decades. Psychiatry, especially State
psychiatry, has redrawn its boundaries, and is now less concerned with
dysfunctional families, and more with using narrow diagnostic criteria to limit
access to services.

It is not at all clear that Laing's
radicalism has made an enduring, independent contribution to psychiatry. His
focus on understanding the experience distress is part of an interpersonal
tradition that predates Kingsley Hall, reaching back to Tuke and other
practitioners of moral therapy. Kingsley Hall folded in 1970, and so was never
able to provide the sort of sustained programs of intervention that might have
tested Laing's theories more fully In the years after Kingsley Hall Laing never
recaptured the status he enjoyed as a counter culture figure.

A biography is a story of a life.
While Barnes' book, especially the chapters by Berke, provides a critique of
mainstream psychiatry, it is as biography that the book is most successful.
From the intensely subjective descriptions of her childhood experiences, to the
frank and at times naively honest recollections of her adulthood, Barnes'
account is direct and compelling account of one woman's life.

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